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Human Health Campus
Human Health Campus
Human Health Campus

Paradoxical pattern in a patient with previous myocardial infarction

Teaching Case

Case presentation:

  • Female.
  • 66 y.o.
  • Previous MI.
  • Dyspnea and non-specific chest discomfort.
  • ECG: Q waves V3-V5.
  • Echo: LVEF 48%, apical hypokinesia.
  • Referred for MPS w/ pharmacologic stress.
  • Dipyridamole + rest (2-day protocol), 99mTc-MIBI.
  • Well tolerated, no symptoms, no ECG changes, BP 130/80 mmHg at rest, 120/75 mmHg during the test.

Teaching points:

  • Myocardial necrosis with a paradoxical pattern (PP) is observed in a few proportion of patients with myocardial necrosis.
  • Necrotic areas with PP have preserved myocardial flow, owing to either patency of the culprit artery, or the presence of collateral circulation to this territory when the artery is occluded.
  • Patients exhibiting a PP on MPS with Tc-99m-labeled tracers have a better prognosis and better LV function than patients with a non-PP pattern in necrotic myocardial regions.
  • PP can also be observed as an artefact in studies with low-count statistics, or if there is dominant attenuation during the stress portion.
  • QC data should be always checked before interpreting MPS.

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